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The Key for Implantation - Endometrium Thickness

The Key for Implantation - Endometrium Thickness 

Stork Fertility Center
Dr. Lee

In IVF, we’ve been discussing the ideal thickness of endometrium for implantation.

Besides, is the criteria the same for both fresh blastocysts and frozen-thaw blastocysts implantation? Will it be the same? We did not have many studies on the above issue.

This September(2018), Human Reproduction, a research team from Canada, using the database of local IVF treatment, analyzed over 40 thousand implantation cycles of both fresh blastocysts transfer(BT) and frozen-thaw blastocysts transfer (FBT).

A result had been found: Clinical pregnancy and live birth rates decline as the endometrial thickness decreases below 8 mm in BT and below 7 mm in FBT cycles.

As shown in the study,in the BT cycle, the pregnancy rate for endometrium thickness ≥8mm is 43.2%, the abortion rate is 22%, the live birth rate is 33.7%. Comparing to the statistics of thickness.

In FBT, the pregnancy rate of endometrium thickness≥7mm is 38.3%~38.4%, the abortion rate is 26~28.4%, the live birth rate is 27.4~28.4%. Comparing to the statistics of thickness.

To conclude, the indicator of endometrium thickness for implantation are as following: 

Fresh blastocysts transfer: ≥8mm

Frozen-thaw blastocysts transfer: ≥7mm

With a good uterus environment, comes with a better clinical outcome. Good things are worth waiting for.   


Hum Reprod. 2018 Sep 17. The impact of a thin endometrial lining on fresh and frozen-thaw IVF outcomes: ananalysis of over 40 000 embryo transfers. Liu KE, Hartman M, Hartman A, Luo ZC, Mahutte N.

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[Success Story] Egg Donation, give my kid back

We lost our daughter on the day before Christmas Eve and could not fall asleep in the following 7 days . One Day, at 2 AM, I bought a magazine at 7-11, went to McDonalds and then ordered a cup of coffee. That was a quiet early morning; nobody was on the street. It made me felt like I was the only person in the world. After two weeks, my husband and I went back to work, because we shouldn’t stay at home and keep thinking about our baby daughter. Both of us are over 40 years old. Our Families, friends and doctors all told us " May her rest in peace, both of you need to let it go and move on." We try to make a new life, we scheduled to travel or be volunteers. One year passed, both of us still felt upset. So we made a decision: to make a IVF baby. In the  following two years, we had done IVF for 3 times. However, all of them were failed. because the reasons might be our eggs were fewer quantities, poor quality, no fertilization and abnormal development. As a result, our doctor told us no oocytes that they found via Ultrasonic and even told us to give up. That day I cried a lot, and told my closed friend. She mentioned about "egg donation". I did hear it before, but didn't understand it at all. However, I kept these words “egg donation” in my mind.

After that, I started searching the information of egg donation. I was so surprised that many moms from Hong-Kong wrote lots of articles about it. In additional, there were many cases from Taiwan and Thailand. Some of articles did provide detailed information. Due to familiar with IVF treatment, it was easy for me to tell the reality of these articles. I was impressed by an article from Stork Fertility Center. That's why I searched the website of Stork Fertility Center, read about their background, service, doctors, cases and the Taiwan Artificial Reproduction Act. After one year consideration, we flew to Taiwan, and began our journey to Stork Fertility Center. The equipments of center were much better than my expectation. In  the beginning, we only wanted to look around the center and doctors and compare to another center. However, after I met Dr. Lai, I could easily understand his professional suggestions. Therefore we decided to process egg donation program with Stork Fertility Center.

The doctor in Hong-Kong wouldn’t like to answer our question and not easily close. Compare to previous experience, Stork Fertility Center has much greater service. The center arranged a personal consultant for us to begin with. She assisted with every process from meeting with doctor, completing all the files, physical examination, Hysterosalpingogram to sperm pick up, she accompanied with us during whole procedure. Besides, the center provided some snacks and lunch. We completed all the processes within a few hours with their amazing teamwork and their professional services. When we reviewed my report, it showed one of my fallopian tube was blocked that was the issue never been brought out before. Therefore, Dr. Lai gave me the treatment for my fallopian tube and then we went back to Hong-Kong and waited for the report of matching and GPS. One week later, we received the report of Hematology test which showed my ANA, ANTI-TPO, and ATA index were higher than normal. I took doctor’s advice and went to see Immunology Doctor. I had been diagnosed with Xeroderma which was one kind of Autoimmune disease by two times of blood test and Nuclear Medicine Salivary Gland Scan. In order to prevent the antibody effect embryo, it was necessary to take medication.

Four month later, I got the news from Stork Fertility Center. We matched a egg donor who provided 17 eggs. after insemination, we had 7 blastocyst. Also we chose to pick 5 to process PGS, we had 3 normal blastocyst. 8 months later after we meet Dr. Lai, we went back to Stork Fertility Center for transferring a normal blastocyst. Dr. Lai smiled and told me " blastocyst looked so beautiful, and endometrial thickness is good with perfect transfer spot." We had less stress than before, and then we went back to Hong-Kong waiting for result. I had strong feeling and confidence of believing in this time would be successful  . I went to Laboratory for blood check, and it's true. I was pregnant.

Because I was with advanced maternal age, so my pregnant period was not quit easy. I had Gestational hypertension, gestational diabetes mellitus, and Sjögren syndrome. Every issue might affect my baby. I still felt so happy to see my baby every month from monthly prenatal exam. As long as I know that she was healthily grow up in my belly, I felt good. Of course I took care my body very carefully. Finally, I gave birth with caesarean section at 37 weeks and got a 5.5 pounds baby girl.

Today, my baby daughter is 7-month-old, the weight is 17 pounds. She is very charming, she is our sunshine. People say she looks like her father who has beautiful eyes. My husband told  me my baby daughter's personality is like me. Of course, she is my daughter! Now, I won't feel lonely anymore, instead I usually tell my daughter" mom needs to do something, so please play by yourself, okay?" "God never shuts one door without opening another." Our past experience was our testimony. Today, we appreciate that Reproductive medicine could bring people hope. And we really feel happiness, and give us chance to hold our daughter’s hands.

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Why do I have miscarriages over and over again?

Being pregnant can be as a duck takes to water, however for many people, it can be easily achieved, but how to "safely reach full-term" seems to be a challenge that is harder than climbing up to the sky.
"Why do I have miscarriages over and over again?"
After having the examination, we found out that some mothers have problems with the immune system that is easy to attack the blastocyst and cause the miscarriage.

The process of pregnancy is a well-designed by the God. The reason why the blastocyst isn’t attacked by the immune system is mainly the barrier formed by the placenta between the fetus and the mother, which can make the immune system unable to identify the fetus as a foreign substance.
Through the effect of hormones, the blastocyst can peacefully coexist with the mother. The mechanism involved in the process is very complicated.  As long as one of them goes wrong, it will destroy the mechanism and allowing the immune system to produce antibodies against the blastocyst during pregnancy. Usually this immunoreaction may be normal before pregnancy.
Once pregnant, the defense mechanism begins to be so problematic that the blastocyst cannot continue implanting and cause abortion.

In general, there are many autoimmune diseases have a strong relationship to habitual abortion such as Antiphospholipid syndrome (APS), Systemic Lupus Erythematosus (SLE), Thrombotic Thrombocytopenic Purpura (TTP) and so on.
Due to the problem of the immune system, it is easy to form the thrombus, block up the blood vessels of the placenta, and cannot supply nutrients to the fetus. Or it can cause the placenta itself to become inflamed, produce antibodies to attack the blastocyst and lead to abortions.

In recent years, it has been discovered that there is an immunocyte in the mother's body called "natural killer cell (NK cell)". Under normal conditions, this immunocyte which is produced by the bone marrow in the blood plays the first line of defense to protect the human body. Induced by the thymus gland, it can attack foreign bacteria and viruses, or kill tumor cells. In addition to the NK cells in the blood, there are NK cell also existed in the uterus. Basically, the NK cells in the uterus are different from the one in the blood. It can not only avoid inflaming but also having considerable benefits for implantation. However, if there are excessive NK cells in the uterus, it may cause infertility or abortion.

Therefore, except for the examination of immune diseases such as complement system (C3, C4), antinuclear antibody (ANA), antiphospholipid antibody (APA) and anticardiolipin antibody (ACA), the concentration of NKcells in the uterus can be included in one of the examination items for habitual abortion.
As long as the concentration of autoantibodies in the body is too high, it's necessary to treat with the medication before pregnancy. The medication is including Aspirin, Steroid, Immunosuppressive drug or Heparin and some patients are suitable the Immune Globulin and Cancer Immunotherapy.

However, it's still a mystery in the medical field that what reasons cause the immunocyte to attack the blastocyst. Therefore, the immune problems and related treatments still need to be evaluated by professional physicians. To increase the pregnancy rate, it’s necessary to deal with it.

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The Grand Opening of our Branch in Taipei City - Stork 11


Back to the future - the secret of 11

With the anticipation by all of the customers of Stork Fertility Center, The grand opening of Stork 11 (Taipei branch) is finally launching! Everything has its own reason. Why we decided to set up a branch? Why we named it Stork 11? And what is our expectation toward Stork 11?

The story began from the financial crisis of 2008. At that time, we launch our egg collection (EC) and blastocyst collection (BC) treatments, two accumulative strategies of oocytes and blastocytes. By means of these two treatments, we encourage our customers with diminished ovarian reserve (DOR) to speed up their path of having a baby. The ideas popped up one day when I was on my way to Starbucks across the street. Surprisingly, I realized the Starbucks, which never has any discount, was having a buy one get one free campaign to overcome the economical distress. During that period of time, I always remind my employees that "getting something to do is better than nothing to do", in case they were fooling around during work time.

The concepts of "similar protocol treatment" and "doing more than we could" became a motivation to help our customer, especially for those who had only 1 to 2 eggs at a cycle, to save the cost of the IVF treatment. After finishing the collection of more than 6~10 mature eggs, they can consider thawing the sperm and performing the insemination at once. This strategy could not only hugely save the cost of treatment but also ease the mental burden of our customer. Most importantly, this act also meets the belief of Stork Fertility center: Helping others may amazingly lead to great self accomplishment.

Since our treatment designs were originated from the customer perspective, our treatments attracted many DOR customers in a very short period of time. As for those who are going to give up and considering the oocyte recipient program, most of them are living in Taipei city with age over 40. I was particularly struck by a case; a 47-year old lady got pregnant and gave birth to her daughter by using her own eggs. Besides her miraculous story, many of our customers with the age of 45 also got pregnant by receiving the treatment in Stork Fertility center. However, some of them can only consider the oocyte recipient program in order to successfully reach the pregnancy. With the accumulation of abundant cases, our experience also indirectly boosted the development of our oocyte bank and oocyte cryopreservation business.

One of our case, Miss S, is a career motivated 37-year old female from the US. Although her AMH value is only 0.79, she never consider giving up on the idea of being a mother. She flew to Taiwan for treatments and 5 times oocyte pick-up operations, because she strongly believes that she can one day realize her dream. For now, she already has 12 mature oocytes for future use.

According to the statistic here in Stork Fertility center, In 2017, we thawed 326 case of donated oocytes from our oocyte bank, which were 5,493 mature oocytes in total. With the survival rate of 94% after thawing, 5,136 oocytes were survived. The fertilization rate is 78% (3,983 embryos), and the good blastocyst rate is 54% (2,133 blastocysts). To sum up, 1 good blastocyst can be created by only using 2.86 mature oocytes in average. The high quality performance and outstanding oocyte survival rate after thawing are owing to not only the leading laboratory techniques but also the strict selection of the ooctye donors (only 8 out of 100 girls could pass the criteria of oocyte donor).

According to the Stork Fertility center Happiness Pregnancy code (P code), female below age of 37 with 15 mature oocytes will acquire 90% of chance to bring a baby home in the future. This means that the dream of Miss. S is definitely worth expecting. The statistic analysis shows that about 13 oocytes will survive after thawing 14 oocytes with no accident. The survived oocytes will lead to 10 fertilized eggs and 5 good blastocysts in the following procedure. The euploid rate of blastocyst for age 35-37 is 43.8%. The pregnancy rate can increase to 60-70% after the Preimplatation Genetic Screening (PGS). What's more, the pregnancy rate can even increase to 70-80% if you also do the Endometrial Receptivity Analysis (ERA, third generation plus). With the personalized precision IVF treatment (PP-IVF), the successful rate of implanting 1 blastocyst with third generation plus examination is 80%. By all these evidences, you will understand what a great chance for Miss. S to fulfill her dream of having a baby in the future.

The future is decided by now! Will you believe in yourself if you are a 35-37 year-old female just like Miss. S? If being a mother is the deepest dream of yours, why don't you start collecting your young oocytes from now? Saving 15 mature eggs as a present for you in the future is also a prevention from being a oocyte recipient and waiving away large amount of money.

Located in Hinschu, in Stork Fertility center, there are about 40% of our customers are from Taipei (foreign customers are also the same amount). Our Taipei branch- Stork 11 finally comes to realization after 10 years of anticipation from our customers. "11" indicates our commitment to all the female below age of 35 (35 is not included) . With 11 mature oocytes cryopreservation, you will have 90% of probability to bring back a baby in the future. Our definite goal is to help everyone realize the happiness and dream of having a baby in your family.

Stork 11 is also a building of Nara. With the combination of our company culture and spirit of art, we also welcome people who love Yoshitomo Nara (奈良美智/ならよしとも) to visit Stork 11.

Stork 11 will also inherit the DNA of Stork Fertility center. We will continuously provide prestigious services in the future.

 ~wrote by Dr. Hsing-Hua Lai, Dean of Stork Fertility Center

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